Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix / Anomalias congênitas e variações anatômicas do apêndice vermiforme e mesoapêndice

ABSTRACT Aim: The purpose of this review was to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies. Methods: The search was carried out in the following databases: PubMed, Science Direct, and SciELO. Results: Thirty-seven studies were included in this review. Among the abnormalities of the vermiform appendix identified are agenesis and duplicity, and anatomical variations were related to length and positioning. Appendicular duplicity was a more frequent abnormality, mainly Type B2, associated with acute appendicitis, followed by agenesis, Type III. The first case of agenesis associated with acute appendicitis and volvulus-type duplicity of the appendix was identified. The most frequent position was retrocecal in adults and pelvic in children. In the mesoappendix, anatomical variations in its positioning, shape, absence, and length were identified. Conclusion: This review sought to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies, contributing to aid in clinical diagnosis and surgical interventions in patients with suspected acute appendicitis.

RESUMO Objetivo: O objetivo desta revisão foi apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas. Métodos: A busca foi realizada nas seguintes bases de dados: Pubmed, Science Direct e Scielo. Resultados: Trinta e sete estudos foram incluídos nesta revisão. Entre as anormalidades do apêndice vermiforme identificada estão agenesia e duplicidade e, variações anatômicas relacionadas ao comprimento e posicionamento. A duplicidade apendicular foi a anormalidade mais incidente, principalmente do Tipo B2, associada à apendicite aguda, seguida de agenesia do Tipo III. O primeiro caso de agenesia associada à apendicite aguda e à duplicidade de apêndice do tipo vólvulo foi identificado. A posição mais frequente foi a retrocecal em adultos e a pélvica em crianças. No mesoapêndice, foram identificadas variações anatômicas em seu posicionamento, formato, ausência e comprimento. Conclusão: Esta revisão procurou apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas contribuindo para o auxílio no diagnóstico clínico e intervenções cirúrgicas em pacientes com suspeita apendicite aguda.

Histomorphometry of human vermiform appendix

Background: Acute Appendicitis is one of the most common acute abdominal conditions. Advances in modern radiographic imaging have improved diagnostic accuracy, however the diagnosis of appendicitis remains essentially an enigmatic challenege. Though much work has been done on morphometry but there is less work done on variation of histomorphometric features of appendix. Hence the study was carried out by keeping the following objectives in mind. Aim was to study the general histomorphology and measure the histomorphometric parameters of human vermiform appendix. And also, to study diagnostic significance of histomorphology and histomorphometric parameters in causing appendicitis.Methods: The study was conducted in the Department of Anatomy. Specimens of appendix were obtained from embalmed cadavers. Serial sections were taken at different levels and slides were prepared. The slides were then examined using Nikon Trinocular Research microscope under magnification power of 40x for various parameters, after staining with H&E.Results: The mean luminal diameter varied from 1.32±0.65mm at base to 1.22±0.72mm from base. Diffuse lymphatic tissue was seen in both mucosa and sub-mucosa.Conclusions: Definitely there is a relationship between lymphoid follicle diameter and mucosal-serosal thickness on one hand and that between the luminal diameter and lymphoid follicle diameter on the other hand. Since our study was restricted to geriatric age group so studies need to be done in different age groups to highlight any further relationship.

Anatomical Variations Of Vermiform Appendix In Gujarat

Background: Head of appendix can be placed in different situations but the base of appendix is connected to thececum. The variation in the situations is classified into six locations: retrocecal, pelvic, subcecal, paraileal,retroileal, and subhepatic.Objectives: To study the variation in the anatomical features, length & external diameter of appendix and itsassociation with age and sex in people in the Gujarat.Material and method: This study was conducted on total 200 cases taken from dissection laboratory of theanatomy department of three different medical college of Ahmedabad during 2009 to 2012. Length of vermiformappendix was measured by nylon thread from root to tip of appendix. Thread’s length was measured by verniercaliper. External diameter was measured by vernier caliper at a maximum external diameter of the appendix.Result: anatomical locations of the appendix which were as follows: retrocecal in 111 individuals (55.5%),pelvic in 47 individuals (23.5%), retroileal in 18 individuals (9.0%), subcaecal in 13 individuals (6.5%), paracaecalin 10 individual (5.0%), and subhepatic in 1 individual (0.5%). a significant association was found between theappendix length and different age groups. The average length of appendix was 55 mm for men and 51 mm forwomen. The average external diameter of appendix was 73 mm for men and 65 mm for women.Conclusion:Retrocaecal appendix has symptoms of upper urinary tract infection, due to irritation of the adjacentureter. In pelvic position pain may be felt when the thigh is flexed and medially rotated, because the obturatorinternus is stretched. Pelvic appendix may irritate the bladder or rectum causing suprapubic pain, pain withurination, or feeling the need to defecate.

Study on morphological variations of cadaveric vermiform appendix and caecum in Narayan Medical College and Hospital

Vermiform appendix is one of the most variable organs inside the abdomen. Unusual positions pose diagnostic and surgical challenges. The present study was conducted on 38 cadavers in Narayan Medical College and Hospital to find the morphological variations of vermiform appendix and caecum. It was seen that the most common position of appendix was retrocaecal (61%) while second most common position was pelvic (21%). Mean length of appendix was found to be 5.98 ± 1.67 cm. Mean outer girth was 2.87 ± 0.36 cm. Mean distance of Vermiform Appendix from ileocaecal junction was found to be 2.58 ± 0.46 cm. Adult type is the most common shape (71%) followed by exaggerated one (18%). Mean length of caecum was 7.61 ± 0.80 cm. and mean width being 8.49 ± 0.88 cm. Knowledge about morphological pattern of appendix and caecum is helpful in proper clinical management.

A clinicopathological study of acute appendicitis in eastern India.

Background: Appendicitis is the most commonly performed emergency abdominal surgery. An accurate and timely diagnosis of acute appendicitis remains a challenge. Objective: This study was performed to determine and correlate between the clinical patterns of acute appendicitis, laboratory and ultrasound findings and pathology found in appendicectomy specimens to help timely diagnosis and reduce negative appendicectomy rate. Methods: This is a cross sectional study, detailed history and clinical examination of the patient was carried out at the time of admission. Operative findings along with any complications as well as histopathological findings were recorded. Patients were followed up for one month for any complications. Results: A total of 125 patients were treated for appendicitis during this period with a male female ratio of 1:1.36. Most common age group was the 2nd decade with mean age being 20 years, while most common symptom was abdominal pain. Ultrasonography showed evidence of acute appendicitis in 85.6% and leucocytosis in 66.4% cases. Although only 5.6% of appendices grossly appeared normal during surgery, histopathology showed 14.4% to be normal. Wound sepsis (24.8%) was the most common post-operative complication. Conclusion: Diagnosis of acute appendicitis in our setting is still based on high index of suspicion following clinical evaluation. Combining this with laboratory findings and ultrasound scan has yielded an acceptable negative appendicectomy rate. We advocate routine use of ultrasound along with clinical evaluation and laboratory tests for the timely diagnosis of acute appendicitis and an early surgical intervention to prevent complications.

An unusual foreign body within the appendix

Ingestion of foreign bodies consist a quite common problem in the pediatric age group. Usually most of them traverse the gastrointestinal tract without complications and only in rare cases they get trapped within the appendix. This case report describes the ingestion of the tip of a mercury thermometer by a six-year-old girl. An elective appendicectomy was performed in order to avoid further complications. To the best of our knowledge, this is the first reported case of the tip of a thermometer within the appendix.

Vermiform appendix: positions and length: a study of 377 cases and literature review / Apêndice vermiforme: posições e comprimento: estudo de 377 casos e revisão de literatura

Objective: Evaluation of the frequency of the relative positions and length of vermiform appendix in a group of corpses examined by the authors. Method: Dissection of 377 adult cadavers autopsied. Results and conclusions: Retrocecal: 43.5%; subcecal: 24.4% post-ileal: 14.3%, pelvic: 9.3%; paracecal: 5.8%; and pre-ileal appendices: 2.4%, other positions: 0.27%, mean length: 11.4 cm. (AU)

RESUMO Objetivo: Avaliação da frequência das posições relativas e do comprimento do apêndice vermiforme em um grupo de cadáveres examinados pelos autores. Método: Dissecção de 377 cadáveres adultos necropsiados. Resultados e conclusões: Apêndices retrocecais: 43,5%, subcecais: 24,4%, pós-ileais: 14,3%, pélvico: 9,3%, paracecais: 5,8%, pré-ileais 2,4%, outras posic¸ões: 0,27%. Comprimento médio: 11,4 cm. (AU)

Umbilical-spinous line: a morphological term that should be included in the anatomical terminology / Linea umbilico-espinosa: un término morfológico que debe incluirse en la terminologia anatómica

Abstract We argue the need to include in the International Anatomical Terminology the term "Umbilical-spinous line" for its importance as a morphological referent in bioscopic and surface anatomy. Also, in order to avoid using eponyms, it is suggested that the traditional term "McBurney point" be replaced by "supra spinous point" as being more descriptive of location.

Resumen Se argumenta la necesidad de incluir en la Terminología Anatómica Internacional el término "línea umbilico-espinosa" por su importancia como referente morfológico en la anatomía bioscópica y de superficie. Además, con el propósito de evitar la utilización de epónimos, se sugiere que el tradicional término "punto de McBurney" sea remplazado por el de "punto supraespinoso", por ser más descriptiva su ubicación.

Unique 28 cm Long Vermiform Appendix.

Vermiform appendix is a vestigial organ in human beings and situated at the ileocaecal junction. It opens into the caecum. It is a narrow tube of varying length. The normal, average length is about 5 cm to 10 cm. The longest vermiform appendix has been reported to be measuring about 25 cm. In the present case a long vermiform appendix was observed in female, formalin fixed, adult cadaver during the routine dissection for medical undergraduates. The Vermiform appendix was retrocaecal and extending to retro colic in position and its length was measured as 28 cms. When such a long vermiform appendix is present, the inflammatory conditions may simulate enteritis, salpingitis or endometriosis of the uterus. Sometimes it may herniate through a weak abdominal wall like the intestines or the peritoneum. Therefore the knowledge of the length and the position of the vermiform appendix are important clinically.

Morphological features and morphometric parameters of human fetal vermiform appendix at different gestational ages.

Background: Vermiform appendix is a vestigial organ of variable position in the abdomen. Its location, size and shape are subject to alterations with the race of the population and limited information is available on developmental morphology and morphometry of fetal appendix. Materials and Methods: In the present study 60 appendix specimens from aborted human fetuses of 17-40 weeks gestational age and both sexes were studied by dissection method for age related morphological features and morphometric parameters. The morphological parameters observed include its location in relation to abdominal region, caecum and ileum, clock position, position of base in relation to caecal wall and direction of tip of appendix. The morphometric parameters of length, diameter and distance between ileo-caecal orifice and appendicular orifice were measured. Results: The location of appendix in relation to abdominal region presented higher incidence of sub-hepatic position in less than 30 weeks fetuses and right iliac fossa location in more than 30 weeks fetuses. Discussion: in comparision with the literature available on adult vermiform appendix the observations in the present study are in favor of influence of developmental processes on the localization of appendix including its base, ileo-caecal orifice, direction of tip, distance from McBurney’s point. Conclusion: Results of this work suggests variability in localization of appendix during prenatal development and the influence of gestational age, sex, size, growth of caecum and gut on its final position and was different from that of adults. There is increase in the morphometric parameters of appendix with increase in gestational age. Both morphological and morphometric parameters were different between sexes.

Cecoscopia, domo de la base del apéndice como localizador de la válvula ileocecal / Cecoscopy, appendix dome for identifying ileocecal valve

Introduction: Ileoscopy during colonoscopy or retrograde enteroscopy, is increasingly required and is considered a quality criteria in colonoscopy. The appendix is found in most cases with his mesoappendix oriented medially in the direction of the ileocecal valve. Because of this, the location of the dome of the base of the appendix should indicate the direction of the ileocecal valve. Methods: Observational study. We included 100 consecutive colonoscopies, in which adequate visualization of cecal pole, appendiceal orifice and its dome, was achieved. We excluded patients with sub-optimal colon preparation and those who had previous appendectomy or right hemicolectomy. The procedures were performed between September 2009 and April 2010, by two experienced operators. Success in finding the ileocecal valve was considered if the direction of the dome of the appendix provided guidance to the location of it and the entrance to distal ileum. Results: We evaluated 100 procedures, in which the distal ileum was entered following the direction of the dome of the appendix in 98 patients (98 percent). In two patients (2 percent) the ileocecal valve was not in the direction provided by the dome of the appendix. In one of them the valve was exactly in the opposite direction of the dome, and in the other was at 90º of it. Conclusions: As described in our series, it seems recommendable to use the dome of the appendicular base for the location of the ileocecal valve and terminal ileum access.

Introducción: La ileoscopia durante la colonoscopia o la enteroscopia retrógrada, es cada vez más requerida y se considera criterio de calidad en colonoscopia. El apéndice se encuentra en la mayoría de los casos con su mesoapéndice orientado hacia medial en la dirección de la válvula ileocecal. Debido a esto, la localización del domo de la base apendicular, debería señalar la dirección de la válvula ileocecal. Material y Métodos: Estudio observacional. Se incluyeron 100 colonoscopias consecutivas, en las cuales se logró una adecuada visualización del polo cecal, y del orificio apendicular y su domo. Se excluyeron los pacientes con preparación de colon sub-óptima, apendicectomizados y hemicolectomizados de colon derecho. Los procedimientos fueron realizados entre septiembre de 2009 y abril de 2010, por dos operadores experimentados. Se consideró éxito en encontrar la válvula ileocecal, si la dirección del domo del apéndice orientaba a la ubicación de ésta y la entrada al íleon distal. Resultados: Se evaluaron 100 procedimientos, en los cuales se ingresó al íleon distal siguiendo la dirección del domo del apéndice en 98 pacientes (98 por ciento). En dos pacientes (2 por ciento) la válvula ileocecal no se encontraba en la dirección que orientaba el domo del apéndice. En uno de ellos la válvula estaba exactamente en la dirección opuesta a la que mostraba el domo, y en el otro estaba a 90º de éste. Conclusiones: Según lo descrito en nuestra serie, parece recomendable utilizar el domo de la base apendicular para la localización de la válvula ileocecal y el acceso al íleon terminal.

Características anatómicas y biométricas del apéndice vermiforme en niños chilenos operados por apendicitis aguda / Anatomic and biometric features of the vermiform appendix in Chilean children operated by acute appendicitis

Las características biométricas del apéndice vermiforme no son constantes en el ser humano, así como tampoco lo es su posición. Los datos sobre sus variaciones aún son limitados, pero muestran la existencia de diferencias dependiendo de la región geográfica y racial de los individuos. En Latinoamérica no existen estudios anatómicos in vivo publicados por lo que las referencias se basan sólo en observaciones post mortem. El presente estudio tuvo como objetivo determinar y describir las características biométricas y posiciones anatómicas del apéndice vermiforme. Para ello se realizaron observaciones directas y mediciones del apéndice vermiforme en 65 niños chilenos, 37 de sexo masculino y 28 del femenino, operados por apendicitis aguda en los hospitales regionales del Maule y Aysén. Se consideraron variables como: ubicación del ciego, posición y longitud del apéndice, forma y número de ramas arteriales del mesoapéndice. La edad y peso promedio fue de 9,7 años y 37,5 kg., respectivamente. El ciego se localizó en la fosa ilíaca derecha en 62 pacientes (95,4 por ciento) y en el flanco derecho en 3 (4,6 por ciento). La longitud promedio del apéndice fue de 7,5 cm. La posición más frecuente del apéndice vermiforme fue la retrocecal (47 por ciento), seguida de la pélvica (29 por ciento). El mesoapéndice fue mayoritariamente triangular, con tres ramas arteriales y se insertó principalmente en el tercio medio del apéndice. La vía de abordaje más frecuente fue la laparotomía de McBurney, seguida de la laparoscópica. La vía de abordaje laparoscópica presenta ventajas relacionadas con un menor tamaño de incisión cutánea, mejor exploración de la cavidad peritoneal, visualización más cercana de los órganos, mayor facilidad en la disección y extracción del apéndice con recuperación más rápida y estadía hospitalaria más corta.

The biometric features of the vermiform appendix are not constant in humans, and neither is his position. Data on its variations are still limited, but show the existence of differences depending on geographic region and race of individuals. In Latin America there are no published in vivo anatomical studies as references are based only on postmortem observations. The aim of this study was to identify and describe the biometric features and anatomical positions of the vermiform appendix. For this purpose direct observations and measurements of the vermiform appendix in 65 Chilean children, of both sexes, 37 male and 28 female, operated for acute appendicitis in Maule regional and Aysen hospitals were performed. Variables such as location of the cecum, appendix position and length, shape and number of arterial branches of mesoappendix. The average age and average weight was 9.7 years and 37.5 kg. respectively. The ceacum was localized in the right iliac fossa in 62 patients (95.4 percent) and in the right flank in 3 patients. The vermiform appendix average length was 7.5 c. In the total sample the most frequent position of the vermiform appendix was retrocecal (47 percent), followed by pelvic (29 percent).The mesoappendix was mostly triangular, with three branch arteries and inserted mainly in the middle third of the appendix. The most common surgical approach was laparotomy McBurney, followed by laparoscopy. The laparoscopic technique has advantages related to a smaller skin incision, better exploration of the peritoneal cavity, close viewing of the organs, easier dissection and removal of the appendix with faster recovery and shorter hospital stay.

Agenesia del apéndice cecal: informe de un caso / Congenital absence of the cecal appendix: case report

Introducción: La agenesia del apéndice cecal es muy rara y fue descrita por primera vez por Morgagni en 1718. La incidencia estimada es de uno por cada 100 mil laparotomías realizadas por sospecha de apendicitis. Se informa este caso con la finalidad de atraer la atención de los cirujanos que se encuentren en situación similar durante la laparotomía. Caso clínico: Hombre de 48 años de edad admitido en la sala de urgencias por dolor abdominal de tipo vago, más notable en epigastrio y mesogastrio, el cual cuatro horas después de iniciado se localizó en la fosa iliaca derecha, acompañado de hiporexia, náusea, vómito y fiebre. A la exploración física se encontró paciente febril, taquicárdico, taquipneico, con peristaltismo disminuido, abdomen doloroso a la palpación y a la percusión en la fosa iliaca derecha. Signos apendiculares positivos. La biometría hemática indicó leucocitosis de 14 mil, neutrofilia (89.60 %) y linfopenia (5.33 %). Las radiografías simples de abdomen no mostraron anormalidades. Se formuló diagnóstico de probable apendicitis aguda, por lo que se efectuó celioscopia, identificándose agenesia apendicular tipo IV de Collins y adenitis mesentérica concomitante. Conclusiones: Se tienen que conocer varios criterios antes de concluir que el apéndice cecal está ausente de manera congénita. El diagnóstico no debe realizarse hasta que la regiones ileocecal y retrocecal hayan sido exploradas.

BACKGROUND: Agenesis of the vermiform appendix is very rare and was first described by Morgagni in 1718. The estimated incidence is 1/100,000 laparotomies performed for suspected appendicitis. This case is reported with the aim of attracting the attention of surgeons who may be in a similar situation during laparotomy. CLINICAL CASE: A 48-year-old male was admitted through the emergency room with the complaint of vague abdominal pain most marked in the epigastrium and mesogastrium which, 4 h after it began, was located in the right iliac fossa and was accompanied by hyporexia, nausea, vomiting and fever. During physical examination, the patient was febrile, tachycardic, and tachypneic, with decreased peristalsis, abdomen painful to palpation and percussion in the right iliac fossa. There were positive appendicular signs. Blood panel showed leukocytosis (14,000), neutrophilia (89.60%) and lymphopenia (5.33%). X-rays of the abdomen showed no abnormalities. We made a presumptive diagnosis of acute appendicitis and the patient underwent celioscopy where surgical findings were reported as type IV Collins appendiceal agenesis and concomitant mesenteric adenitis. CONCLUSIONS: Several criteria must be determined before the surgeon can conclude that the appendix is congenitally absent. Diagnosis should not be confirmed until the ileo- and retrocecal regions have been explored.

Extent of Mesoappendix of Vermiform Appendix in Bangladeshi People.

Background: The mesentery of the appendix extends almost to the appendicular tip along the whole tube or may not be to the tip. The mesoappendix has a free border which carries the blood supply to the organ. Failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation occurs during inflammation. Objective: This cross sectional study was carried out to advance our knowledge regarding the extent of mesoappendix in Bangladeshi people and also to find out the variations in the anatomical positions of the vermiform appendix in Bangladeshi population and their distribution according to the sex. Methods: A total of 100 (60 male and 40 female) specimens of vermiform appendix were collected of different age and sex during postmortem examination in the morgue of Mymensingh Medical College from July 2006 to June 2007. Data was collected by convenient sampling technique. Results: In this study pelvic position of the vermiform appendix were common in both sexes. The two thirds extension of mesoappendix was found in 45% cases where as in pelvic position it was 26 (14 male and 12 female) cases. Half and whole extension of mesoappendix were found in 31% and 24% cases respectively. Among half extension of mesoappendix, retrocaecal position were found to be more (12) than other positions. In whole extension of vermiform appendix pelvic position were found to be common (16) than others. Conclusion: This study provides certain basic information of extent of mesoappendix of vermiform appendix of Bangladeshi population which is responsible for vascularization of the organ and severity during inflammation.

Development of the vermiform appendix inchildren from different age ranges

There is no precise anatomical trace that limits the vermiform appendix of the cecum in the newborn and in the child in the first years of life. The appendix presents a conical form, with an enlarged base and a narrow apex. The objective of the present work was to identify certain anatomical parameters, and to relate them chronologically to the different age groups in order to define when exactly the base of implantation of this organ in the cecum resembles the adult’s anatomy. Sixty-seven (67) ileocecal transition pieces were grouped according to the different age groups: Group A (18 pieces of newborns at term) – Group B (14 pieces of six months-old children) – Group C (13 pieces of 12 month-old children) – Group D (11 pieces of 24 month-old children) and Group E (11 pieces of adults). The point of contact of the ileum anti-mesenteric edge in the cecum was identified and the distance between this and the edges, right (d.r.e.i) and left (d.l.e.i.), of the appendix implantation was assessed. The results were demonstrated through the crossing of variables in the different age groups and the statistical significance level was considered for p < 0.05. From the sixty-seven (67) pieces, forty-seven (70.1%) were obtained from males and twenty (29.9%) from females. The average extension of the vermiform appendix length was 5.3 cm. The retro ileum position was predominant in the first year of life (groups A, B and C). The average of the variables according to the age group (groups A, B, C, D and E) was: D.L.E.I. = 0.0-0.0-0.5-2.0-2.5 cm respectively. D.R.E.I. = 1.1-1.0-1.3-2.3-2.8 cm respectively. DIAMETER of the BASE = 1.0-0.8-0.4-0.3-0.5 cm respectively. The crossing of the average values of the distances from the left margin of the appendix base to the ileum (d.l.e.i.) was performed in groups A, B, C and D with the average value in group E (adult)...

Posición anatómica y longitud del apéndice vermiforme en una población de raza mestiza de la ciudad de Bucaramanga - Colombia / Anatomical position and length of caecal appendix in a mixtured population from Bucaramanga

Antecedentes: La posición y longitud del apéndice vermiforme en el ser humano no son constantes y los datos sobre sus variaciones son limitados. Estudios previos soportan que algunas posiciones particulares o apéndices muy largas pueden confundir los signos clínicos de una apendicitis. Algunos autores afirman que el curso de una apendicitis puede estar influenciada por la posición del apéndice. Método: La posición y longitud del apéndice cecal fueron estudiados en 100 especímenes cadavéricos de población mestiza en Bucaramanga - Colombia. La posición del apéndice se dividió en 6 grupos: pélvica, retrocecal, preileal, postileal, subcecal y paracecal. La posición fue estudiada in situ. Resultados: La posición predominante fue el retrocecal 41%. Igualmente, se encontró un porcentaje elevado de posición pélvica 28%. El promedio de la longitud del apéndice fue de 7.1 cm. Conclusión: El porcentaje de la posición retrocecal de nuestro estudio concuerda con otros estudios realizados en especímenes cadavéricos. Algunos autores han reportado porcentajes elevados de posición pélvica especialmente en poblaciones de raza negra. La posición pélvica del apéndice cecal puede producir dolor hipogástrico confundiendo los síntomas clínicos principalmente en mujeres. Los resultados de este tipo de investigaciones son importantes porque las relaciones de variables anatómicas son usadas en imágenes clínicas de apendicitis aguda; además éstas observaciones pueden alentar la mayor realización de apendicectomías por laparoscopia. [Corzo EG, Forero PL, Amaya L, Bohórquez D, Bohórquez S. Posición antómica y longitud del apéndice vermiforme en una población de raza mestiza de la ciudad de Bucaramanga. MedUNAB 2009; 12:116-120].

Background: The position and length of the vermiform appendix in humans has no constant and the data on the variations in its position are limited. Previous studies support that particular positions and very long appendix could confuse the clinical signs of appendicitis. Some authors affirm that the course of acute appendicitis is influenced by the position of the appendix. Methods: The position and length of the vermiform appendix were studied in one hundred cadaverous specimens of mestizo population from Bucaramanga - Colombia. The appendix positions were divided into six groups: pelvic, retrocaecal, preileal, postileal, subcaecal and paracecal. The position were studied in situ. The data analysis was made from Universidad Autónoma de Bucaramanga's Medical Faculty's Anatomy Department. Results: The predominant position was retrocaecal 41%. Also we found a high percentage of pelvic position 28%. The average length of the appendix was 7.1 cm. Conclusion: Our percentaje of retrocaecal position agreement with other studies in cadaveroys specimens. Some authors have reported high pelvic position especially in black population. Pelvic position in caecal appendix could generate hypogastric pain confusyng the clinical symptoms principaly in women. The results of these investigations are important because the variable anatomical relations are used in clinical imagen of acute appendicitis; furthemore this observations may encourage greater utilization of laparoscopic appendectomy. [Corzo EG, Forero PL, Amaya L, Bohórquez D, Bohórquezx S. Anatomical position and length of caecal appendix in a mixtured population from Bucaramanga. MedUNAB 2009; 12:116-120].

Amyand's Hernia with Periappendicular Abscess

The presence of a vermiform appendix in an inguinal hernia is known as Amyand's hernia. It is rare condition that occurs in about 0.51% of the cases of inguinal hernia. Appendicitis within an Amyand's hernia is found in 0.10% of all forms of external hernia sacs. It is often misdiagnosed as a strangulated inguinal hernia. We experienced a case of Amyand's hernia with a periappendicular abscess within a right inguinal hernia sac in a 71-year-old male patient. Combined appendectomy and Bassini's herniorrhaphy were performed. The patient had an uncomplicated postoperative course and he was discharged 8 days after admission.

Length of Human Vermiform Appendix in Bangladeshi People.

The study was done to find out the length of human vermiform appendix in Bangladeshi people to magnify the knowledge regarding the diverse length of human vermiform appendix in our population. A total 100 vermiform appendix were measured with different age and sex during routine postmortem examination in the autopsy laboratory of forensic medicine department of Mymensingh Medical College. This cross sectional study was done by convenient sampling technique. For convenience of differentiating the length of vermiform appendix in relation to different age and sex, findings were classified in four groups (up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years). Length of vermiform appendix was 2.6 cm to 14 cm. Mean length was 7.9 cm in female and 7.56 cm in male. The highest mean length of vermiform appendix in group A was 9.17 cm and lowest was 5.93 cm in group D.

Anatomical Positions of Vermiform Appendix in Bangladeshi People.

The study was done to see the incidences of different anatomical positions of vermiform appendix in Bangladeshi people to increase the knowledge regarding variational anatomy in our population. A total 100 vermiform appendix (male-60, female-40) were observed in situ on cadaver of different age and sex during routine post mortem examination in the autopsy laboratory of Forensic Department of Mymensingh Medical College. This cross-sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the incidences of different positions of vermiform appendix in relation to age and sex findings were classified and analyzed in four age groups (up to 20 year, 21 - 35 years, 36 - 55 years, 56 - 70 years) and in different sex. In the present study, the pelvic position of vermiform appendix was the most common position in all age groups and pelvic positions were found in 47% cases. The retrocaecal position was the second highest position (22%) and pre ileal position was the lowest (10%) in number. In respect to sex, incidences of pelvic variety of vermiform appendix were more in male than female.

Torsión del apéndice cecal asociada a invaginación intestinal / Torsion of the vermiform appendix associated with intussusception

La torsión del apéndice vermiforme es muy rara; en la literatura sólo han sido referidos 25 casos. El aquí informado es el primero asociado a invaginación intestinal. Se trató de una niña de dos meses de edad quien súbitamente dio muestras de dolor. En la exploración quirúrgica se encontró invaginación ileocecal apretada, que fue corregida. Cuatro días después fue necesario reoperar, encontrando torsión y perforación del apéndice cecal; se practicó apendicectomía. Por datos de obstrucción y peritonitis se requirió nueva exploración quirúrgica en la que se encontró dehiscencia del muñón y perforación cecal. Una vez corregidas estas complicaciones, la paciente evolucionó satisfactoriamente y fue dada de alta en buenas condiciones.

BACKGROUND: Vermiform appendix torsion is a rare condition, with only 25 cases recorded in the international literature. Our patient is the first case associated with intussusception. CASE REPORT: A 2-month-old female infant suddenly developed severe abdominal pain due to ileoceal intussusception. During surgical exploration, a tight intussusception was reduced. Three days later, a new laparotomy was required and we found torsion and perforation of the vermiform appendix. The patient underwent appendectomy, but there was dehiscence of the appendiceal stump and cecal perforation requiring a new surgical exploration. The patient had an uneventful recovery.